Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Dec 2013
Biography Historical ArticleNeurosurgical work during the Napoleonic wars: Baron Larrey's experience.
Considered as the most famous French military surgeon, Dominique-Jean Larrey (1766-1842), who joined all the campaigns of Napoleon, wrote his memoirs and several medical articles. This paper discusses how in the Napoleonic times, Larrey dealt with neurosurgical diseases or injuries. ⋯ In his work, Larrey (and all his contemporaries) dealt essentially with "cranial" surgery, as in skull fractures where the brain could potentially have been injured by bone fragments. The time for brain surgery had not come yet.
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Clin Neurol Neurosurg · Nov 2013
Observational StudyIncreased ventriculostomy infection rate with use of intraventricular tissue plasminogen activator: a single-center observation.
Intraventricular tissue plasminogen activator (alteplase) has been advocated for prevention of vasospasm in aneurysmal subarachnoid hemorrhage and treatment of traumatic or spontaneous intraventricular hemorrhage. External ventricular drain (EVD) insertion is often performed to manage increased intracranial pressure and hydrocephalus associated with these disease states. EVD-related ventriculitis is a serious infection with an up to 50% mortality rate. ⋯ Intraventricular alteplase use may increase ventriculitis risk. Currently, we reserve intraventricular alteplase for patients with EVDs obstructed by hematoma accompanied by increased intracranial pressure.
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Clin Neurol Neurosurg · Nov 2013
ReviewPain in Parkinson's disease: analysis and literature review.
Pain is a common problem faced by Parkinson's disease (PD) patients. Despite its impact and disabling effects pain is still frequently overlooked. In this study we analyze a representative sample of peer reviewed literature for the prevalence and types of pain in PD, the impact and significance of pain in the quality of life of the PD patient and the challenges inherent in the diagnosis and management of pain in PD patients. ⋯ We conclude that pain in is an under-recognized and under treated symptom in PD patients. Effective management of pain in PD patients would significantly improve their quality of life. Our analysis is in line with current thinking that identifies PD is much more of a multisystem disease with non-motor symptoms than previously thought.
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Clin Neurol Neurosurg · Nov 2013
ReviewDeep brain stimulation of the subthalamic nucleus in Parkinson's disease: surgical technique, tips, tricks and complications.
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has become a frequently performed surgery in patients with advanced Parkinson's disease. The technique has been further refined throughout the years by improved imaging techniques, advanced neurophysiological recording possibilities, and advances in hardware and software technology. ⋯ Tips and tricks, complications and their management are the main elements of this article. In addition, we provide scientific information from our research and other groups in specific sections.
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Clin Neurol Neurosurg · Nov 2013
Long-term seizure outcomes following resection of supratentorial cavernous malformations.
Symptomatic supratentorial cavernous malformations may present with seizure, headache, neurological deficit, or a combination thereof. Factors that contribute to treatment algorithms commonly include patient age, lesion size and location, lesion multiplicity, hemorrhage history, and the ability to control seizure activity with medication. A better appreciation of the impact of patient and lesion characteristics on post-operative seizure control may provide insight into management strategies. To determine long-term seizure outcomes following surgical resection of supratentorial cavernous malformations, the predictive value of characteristics including seizure duration and number, presence of generalized seizures, and lesion multiplicity and size on seizure control rate was evaluated. ⋯ Resection of supratentorial cavernomas is associated with a high rate of postoperative seizure freedom. The presence of multiple cavernomas is predictive of seizure persistence following surgery.